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Medsurg1 Exam 2 Practice Questions Part 1 (Upper Respiratory Probs)

Terms in this set (64)

Keep the obturator in an easily accessible place at the bedside (e.g., taped to the wall) so that it can be used quickly in case of accidental decannulation. A tracheostomy tube with an inflated cuff is used if the patient is at risk of aspiration or needs mechanical ventilation. Because an inflated cuff exerts pressure on the tracheal mucosa, it is important to inflate the cuff with the minimum volume of air required to obtain an airway seal. High cuff pressure may compress tracheal capillaries, limit blood flow, and predispose the patient to tracheal necrosis. When the patient is not at risk for aspiration, the cuff may be deflated to allow the patient to talk and swallow more easily. Before deflation, have the patient cough up secretions, if possible, and suction the tracheostomy tube and then the mouth. This step is important to prevent secretions from being aspirated during deflation. The cuff is deflated during exhalation because the exhaled gas helps propel secretions into the mouth. Have the patient cough, and then suction the tube after cuff deflation. Assess the patient's ability to protect the airway from aspiration. Remain with the patient when the cuff is initially deflated. If needed, re-inflate the cuff during inspiration. Take care not to dislodge the tracheostomy tube during the first 5 to 7 days when the stoma is not mature (healed). A physician performs the first tube change usually no sooner than 7 days after the tracheostomy. If the tube is accidentally dislodged, immediately attempt to replace it. Severe dyspnea may progress to respiratory arrest. If this situation occurs, cover the stoma with a sterile dressing, and ventilate the patient with bag-mask ventilation over the nose and mouth until help arrives. If a patient has had a total laryngectomy, there will be complete separation between the upper airway and the trachea. Ventilate this patient through the tracheostomy stoma. Initially, tracheostomy patients should receive humidified air to compensate for the loss of the upper airway to warm and moisturize secretions. Humidification is essential to prevent retention of tenacious secretions and formation of mucous plugs. Change the tube approximately once a month after the first tube change. If drainage is excessive, place dressing around tube. A tracheostomy dressing or unlined gauze should be used. Do not cut the gauze because threads may be inhaled or wrap around the tracheostomy tube. Change the dressing frequently. Wet dressings promote infection and stoma irritation. (Lewis 508)